NHS staff and organisations that ‘wilfully’ or ‘recklessly’ harm patients should face new criminal penalties, a major review said yesterday.

It also demanded legal sanctions against leaders in the NHS with a ‘couldn’t care less’ attitude or who deliberately withhold information.

The review headed by Professor Don Berwick, a world expert in patient safety, said there have been repeated safety defects in the NHS with too many patients and carers suffering as a result.

Facing both ways: Health Secretary Jeremy Hunt ruled out minimum staffing levels in the health service but admitted cutbacks can hit safety

It called for a culture of transparency that puts patient safety above targets, especially financial goals.

Continually improving patient safety
should ‘permeate every action and level in the NHS’, said the review
commissioned by the Government in the wake of the public inquiry into
the Mid Staffordshire scandal where hundreds of patients were routinely
neglected and died. Managers chasing financial targets were partly
blamed.

The Berwick report set out measures
including a review of staffing ratios to ensure that sufficient numbers
are on duty at all times, and simplifying an over-complex regulatory
system run by many different agencies.

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The National Institute for Health and
Care Excellence (Nice) should come up with a formula to help NHS leaders
check that hospital wards are properly staffed, with research
suggesting one registered nurse per eight patients, but locally
implemented.

However, Prof Berwick said changing
the culture of the NHS would ‘trump’ any new rules and strategies, and
he stressed that accidental errors by staff would not be subject to
criminal prosecution under the new system.

But organisations that mislead
regulators or hide evidence would face criminal sanctions along with
staff who wilfully mistreat or neglect patients causing serious harm or
death. He said: ‘Where there is wilful or reckless neglect of patients
there needs to be consequences.’ But it would affect ‘a very small
number of cases’.

Guru: Prof Don Berwick was a key White House aide and championed President Obama's Medicare scheme

Prof Berwick stopped short of saying a
duty of candour should be enshrined in law requiring NHS staff to
report beliefs about serious incidents, saying it was already included
in professional codes of conduct.

He also said it would be a
‘bureaucratic nightmare’ for staff to be obliged to follow an automatic
duty of candour where patients are told about every error or near miss.

Prof Berwick, a former adviser to President Barack Obama, said most staff were trying to do their best.

But his report said supervisory
regimes and regulation in the NHS should avoid ‘diffusion of
responsibility’, adding: ‘When so many are in charge, no one is.’ There
should be a review of such organisations including the much-criticised
Care Quality Commission by 2017.

Harm: David Cameron asked US President Barack Obama's former health adviser Don Berwick to review how to change the culture of the NHS

Campaigners warned the review was
another in a long line of ‘navel gazing’ reports into NHS shortcomings
with few practical answers.

But Health Secretary Jeremy Hunt said
it was a ‘call to action’ for the NHS although he did not accept that a
national staffing minimum was necessary.

He said there was a danger that
hospitals would settle for achieving the minimum even though there would
be times when they would need to go beyond it. Katherine Murphy, chief
executive of the Patients Association, said the report was ‘heavy on
platitudes but light on practical solutions’.

Roger Goss, of the group Patient
Concern, added: ‘Unless the Government implements mandatory minimum
nursing staff levels per ward and a duty for all staff to tell patients
when their care goes wrong, staff will carry on as usual.’

Shadow health secretary Andy Burnham
said: ‘All the experts are now telling the Government to get a grip on
staffing levels. Over 800 nursing jobs were lost last month alone – now
totalling almost 5,000 since the election.’

Niall Dickson, chief executive of the
General Medical Council, said: ‘This important report puts safety first
and, if implemented, will improve care and save lives.’